Clinical Education in Private Practice: An Interdisciplinary Project

Education of rehabilitation professionals traditionally has occurred in acute care hospitals, rehabilitation centres, and other publicly funded institutions, but increasing numbers of rehabilitation professionals are now working in the community in private agencies and clinics. These privately owned clinics and community agencies represent underutilized resources for the clinical training of students. Historically, private practitioners have been less likely to participate in clinical education because of concerns over patient satisfaction and quality of care, workload, costs, and liability. Through a program funded by the Ministry of Health of Ontario, we conducted a series of interviews and focus groups with private practitioners, which identified that several incentives could potentially increase the numbers of clinical placements in private practices, including participation in the development of student learning objectives related to private practice, professional recognition, and improved relationships with the university departments. Placement in private practices can afford students skills in administration, business management, marketing and promotion, resource development, research, consulting, networking, and medical-legal assessments and processes. This paper presents a discussion of clinical education issues from the perspective of private practitioners, based on the findings of a clinical education project undertaken at Queen's University, Kingston, Ontario, and previous literature. J Allied Health. 2004; 33:47-50.

THE RECRUITMENT AND RETENTION of clinical education placements for rehabilitation science students, particularly in rural and remote communitiese, is of major concern worldwide.1-5 In Canada, changing health care structures have affected significantly clinical education practical training resources. Although most physical therapists and occupational therapists traditionally have worked in publicly funded institutions, increasing numbers now are working in the community, employed by private agencies and clinics.2,4-6 Evidence suggests that private practices represent underused resources for clinical training of rehabilitation professionals.

Rehabilitation professional education has been geared to practice in acute care hospitals, rehabilitation centers, and related institutions; students have tended to choose clinical education placements that reflect this training.7,8 Although the literature describes innovative curriculum models and strategies focused on educating students for community practice and increasing student interest in working in smaller and more remote areas, learning objectives have tended to relate to culture, role definition, health determinants, health promotion, and community resources and advocacy.5,8 There has been little reference to the inclusion of education and skill training in the area of private practice specifically.

Confounding this issue is the fact that private practitioners are less likely to participate in clinical education than therapists working in traditional institutions.2,6,7,9 Although the literature is scarce in this area, MacPhee and Kotlarenko2 reported many concerns about having students, including patient satisfaction and quality of care, reduced patient load, decreased revenues, liability issues, and student selection. Similarly, a study by Bridle and Hawkes9 found that private practitioners avoided clinical supervision roles because of workload, liability, cost, or scheduling issues. This article discusses clinical education issues from the perspective of private practitioners, based on the findings of a clinical education project undertaken at Queen's University, Kingston, Ontario, and previous literature.

Rehabilitation Therapy Clinical Education Project in Ontario

In 1996-97, the Ministry of Health of Ontario, Canada, provided grants, administered by the Ontario Council of University Programs in Rehabilitation Science (OCUPRS), to fund projects aimed at enhancing the clinical education opportunities for rehabilitation professionals, including occupational therapists, physical therapists, audiologists, and speech-language pathologists. …

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